| NPI | 1497287791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: CA A193745) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX V8924) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2025-11-06 |